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  • Review Article
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Management of the metabolic effects of HIV and HIV drugs

Nature Reviews Endocrinology volume 8, pages 11–21 (2012)Cite this article

Subjects

Abstract

Morphologic and metabolic abnormalities, including subcutaneous adipose tissue wasting, central adipose tissue accumulation, dyslipidemia and disorders of glucose metabolism are common among HIV-infected patients receiving highly active antiretroviral therapy (HAART) and contribute to the risk of cardiovascular disease in this population. The pathogenesis of these disorders is due to complicated interactions between effects of chronic HIV infection, HAART medications and patient factors, including genetic susceptibility. HAART has transformed HIV into a chronic condition for many patients and as a result the majority of HIV-infected patients in many areas of the developed world will soon be aged ≥50 years. Given that metabolic and cardiovascular diseases increase with aging, knowledge of the optimal management of these conditions is essential for practitioners caring for HIV-infected patients, including endocrine subspecialists. This Review highlights the clinical management of these disorders, focusing on the latest evidence regarding the efficacy of treatment strategies, newly available medications and potential interactions between HAART medications and medications used to treat metabolic disorders.

Key Points

  • Subcutaneous lipoatrophy, central lipohypertrophy, dyslipidemia and insulin resistance are common among HIV-infected individuals and probably contribute to these patients' increased risk of type 2 diabetes mellitus and cardiovascular disease

  • The cause of these disorders is multifactorial and includes the effects of chronic HIV infection, direct and indirect toxicity of highly active antiretroviral therapy (HAART) and demographic, behavioral and genetic susceptibility factors

  • Aggressive treatment of modifiable cardiovascular risk factors is warranted, but interactions between HAART and medications to treat metabolic disease, such as certain statin medications, should also be considered

  • A new medication for the treatment of central lipohypertrophy is now available, tesamorelin, but more work is needed to understand its long-term benefits and risks

  • Chronic inflammation in HIV-infected individuals probably has an important role in the pathogenesis of their metabolic disease, but further investigation of this effect and effective intervention strategies are required

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Figure 1: A 45-year-old HIV-infected woman with a | moderate to severe facial lipoatrophy with marked adipose tissue wasting in the malar areas with extension of adipose tissue wasting to buccal and temporal areas, and b | central lipohypertrophy with a large dorsocervical fat pad.
Figure 2

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Acknowledgements

This work was supported by grant NIH/NCCAM K23 AT002862 to TTB and grant NIH/NIAID K24 AI078884 to MJG. Written consent for publication was obtained from the patients for the inclusion of Figures 1 and 2.

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  1. Division of Endocrinology and Metabolism, Johns Hopkins University, 1830 East Monument Street, Baltimore, 21287, MD, USA

    Todd T. Brown

  2. Division of Infectious Diseases, Weill Cornell Medical College, 525 East 68th Street, New York, 10021, NY, USA

    Marshall J. Glesby

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T. T. Brown declares associations with the following companies: Abbott (consultant), EMD Serono (consultant), Gilead (consultant), GlaxoSmithKline (grant/research support), Merck (grant/research support), Theratechnologies (consultant), Tibotec (consultant), ViiV Healthcare (consultant). M. J. Glesby declares associations with the following company: Pfizer (consultant, grant/research support).

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Brown, T., Glesby, M. Management of the metabolic effects of HIV and HIV drugs. Nat Rev Endocrinol 8, 11–21 (2012). https://doi.org/10.1038/nrendo.2011.151

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